Provider Demographics
NPI:1902841299
Name:LOGIN, WENDY P (MSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:P
Last Name:LOGIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BITTERSWEET DR
Mailing Address - Street 2:
Mailing Address - City:GALES FERRY
Mailing Address - State:CT
Mailing Address - Zip Code:06335-1002
Mailing Address - Country:US
Mailing Address - Phone:860-464-7458
Mailing Address - Fax:708-585-0700
Practice Address - Street 1:27 BITTERSWEET DR
Practice Address - Street 2:
Practice Address - City:GALES FERRY
Practice Address - State:CT
Practice Address - Zip Code:06335-1002
Practice Address - Country:US
Practice Address - Phone:860-464-7458
Practice Address - Fax:708-585-0700
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0012551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140001255CO01Medicare UPIN